Our New Year is off to a fast start with an onslaught of Medicaid news. The Centers for Medicare and Medicaid Services (CMS) has proposed major changes with the Medicaid Fiscal Accountability Rule (MFAR). The Department of Health and Human Services has also proposed the Healthy Adult Opportunity using a “block grant” approach. These changes could impact pregnant women covered by Medicaid.
A new report prepared by the National Center for Health Statistics (NCHS) details findings on maternal mortality in the U.S. Hopefully, we now have an accurate analysis because previously, not all states reported data in the same way. NCHS uses the World Health Organization (WHO) definition for maternal mortality as deaths of women while pregnant or within 42 days of being pregnant or from any cause related to pregnancy.
This new report states U.S. maternal mortality rates are 17.4 deaths per 100,000 births, exceeding other developed countries. Racial and ethnic disparities include 37.1 deaths per 100,000 for non-Hispanic blacks versus 14.7 for non-Hispanic whites and 11.8 for Hispanic women. This data confirms the U.S. has the highest maternal mortality rate when compared to nations with 300,000 or more live births. Simply put, in this country we have a crisis with women’s health.
The new data (after correcting death certificate reporting) is alarming as Texas ranked 13th highest among 25 states and is higher than the national average. Texas reported 18.5 deaths per 100,000 births in 2018, according to the NCHS report. A 2018 report investigating maternal mortality in Texas found that with appropriate intervention, nearly 80 percent of pregnancy-related deaths could have been prevented in 2012.
“That such a significant proportion of these deaths can be prevented speaks to all of us to do what we can to improve the health care of women,” said Dr. Lisa Hollier, a Texas Children’s Hospital obstetrician-gynecologist and the chair of the task force. “That means best policies from legislators, best practices from health facilities and physicians, and community efforts to provide education for pregnant and postpartum women.”
All stakeholders must work collaboratively to ensure pregnant women have coverage and access to medical care in Texas. We must have appropriate Medicaid coverage after childbirth based on improving maternal mortality rates, especially addressing racial and ethnic disparities. The new MFAR-proposed changes could negatively impact initiatives striving to improve maternal mortality rates.